During pregnancy, a mother’s overall health, as well as the in utero environment, help shape a baby’s health and future wellbeing. In particular, the fetal brain is undergoing a complicated, yet beautifully orchestrated, developmental construction. Disruption to this development could result in life-long health problems. In fact, many childhood neurological disorders have their roots in fetal life.

At MIRI, investigators are studying the basic mechanisms of fetal neurological disorders and are developing new diagnostic technologies and treatment strategies that could help improve future neurodevelopmental outcomes. Utilizing high-resolution state-of-the-art fetal brain imaging technologies and cutting-edge gene expression analysis methods that can be safely used for the living human fetus, investigators at MIRI hope to advance knowledge of fetal brain development and integrate safe fetal treatments to improve the overall and lifelong wellbeing of children.

Premature birth is a major health problem. Even today, little is known about how to prevent it. At present, 12.3% of live births in the United States are preterm. Despite many advances in prenatal care, this rate increased 31% in the 27-year period from 9.4% in 1981 to 12.3% in 2008. Worldwide, 15 million babies are born prematurely. Africa has the highest rate of preterm birth, but surprisingly, North America has the second highest rate. Preterm birth presents a higher risk than full term birth for infant mortality and a broad range of lifelong health and developmental problems, including acute and chronic respiratory, gastrointestinal, immunologic, hearing, vision, motor, cognitive and behavioral disorders. The annual costs of medical expenses in the U.S. related to preterm birth are approximately $26 billion. This does not begin to measure the emotional impact on an individual’s or family’s life or to society. For the smallest and sickest premature infant born at less than 28 weeks, medical costs in the first year of life average $190,467 (Source: Institute of Medicine 2007). In contrast, a baby delivered at full term incurs medical costs averaging $3,325. Furthermore, formerly preterm babies generate long-term health care costs for treatment of conditions such as chronic lung disease or developmental disorders related to complications of their prematurity.

Salivary diagnostics is a rapidly emerging field aimed at integrating the latest technological advancements to deliver accurate, noninvasive testing platforms into clinical care. Such platforms are ideal for vulnerable newborns, in whom invasive procedures are prohibitive, particularly because repeated blood sampling exaggerates anemia and increases the need for blood transfusions.

Saliva is a rich source of proteins, genetic material (DNA and RNA), microbes, electrolytes and other biomarkers that may be monitored repeatedly without inflicting trauma to infants. Developing salivary diagnostic assays for the neonatal population provides an innovative approach to monitoring aberrant development, infection, and systemic disease.

The multidisciplinary uses of salivary diagnostics in Dentistry, Medicine, Pediatrics, and Industry are the theme of the annual North American Saliva Symposium: http://www.salivasymposium.com/

Maternal obesity is a major public health crisis that has emerged over the past 20 years. Currently, 1 in 3 pregnant women in the United States is obese. Maternal obesity results in higher rates of cesarean section, higher rates of infant birth defects and a three-fold higher incidence of neonatal death. Babies born to obese mothers, even if born at a normal weight, are predisposed to obesity and metabolic dysregulation through the lifespan.. Recent data from NICHD suggests that excessive weight gain in pregnancy, regardless of pre-pregnancy BMI, also predisposes to hypertension, preeclampsia, and infant cardiac defects.

The enormous amount of new knowledge generated by the Human Genome Project and the rapid advancement of high-throughput DNA sequencing technologies have created new opportunities to advance the clinical care of pregnant women and their newborns. There is a need, however, to develop safer, more accurate, and more cost effective prenatal testing, as well as to develop new treatments that can begin in the womb, by giving pregnant women medications that are targeted for their fetuses. In addition, analysis of gene expression can determine the functional stage of maturity for a premature baby, which can lead to personalized diagnosis and therapy in the NICU, as opposed to the “one size fits all” approach that is currently used.

Breastfeeding: It's Complicated

MIRI Investigator Jill Maron, MD, MPH debunks the myth that breastfeeding comes easily and is instinctual to every newborn.